Brian Ahier is a nationally recognized health IT worker with a deep understanding of the technical and policy considerations focus on data exchange, population health, and analytics. He is a Digital Health Evangelist at Medicity, a business of Aetna. He worked for eleven years as Health IT Evangelist for Mid-Columbia Medical Center and then ran a successful consulting practice before joining Medicity. He has served on several committees, workgroups and task forces of numerous leading health IT organizations including HL7, CHIME, HIMSS, and WEDI as well as the Office of the National Coordinator. His passion is to see the effective use of technology assist in transforming our health system to one that rewards quality of care rather than quantity.
HOW DID YOU GET TO BECOME AN EXPERT IN HEALTH TECH?
It’s sort of a passion of mine to solve difficult problems with the use of technology, including Health Care, which has been my focus for the last twenty years. My mother suffered from early onset Alzheimer’s disease which was very aggressive and rapid. I found that the care she was receiving for the last few years of her life was lacking in coordination and was often disconnected and disjointed across the board, which was particularly frustrating from a technologist’s perspective. During this period (1988), it was made obvious that the majority of hospitals were not optimising the level of technology that was readily available within the Health Care Departments. The primary way of exchanging health information back then was via the fax machine which is still used today!
Moving forward my interests grew more and more. I gained a job as a Director of Medical Records for an organization that ran long-term care and skilled-nursing facilities. As the years went on and my experience progressed, I wanted to improve the situation. I found myself engrossed with hospitals and their links to government, which was and sort of still is where the main problem is. I then took a job at a local hospital, working my way up within the IT department, working in various capacities. Until finally, 13 years later, I have so many more opportunities. I have gotten to know now what the specific issues were with various problems, still driving technology. With my knowledge in IT, this infrastructure definitely helped me to succeed. One of my other passions is behind a volume-based payment model, where a professional performs an action for a patient, receives a code for the item and then gets paid. It didn’t actually matter if the patient gets better or worse! In fact it’s better if they do not recover so quickly in terms of the amount of income received. One of my other passions is behind the transition from a volume-based payment model to the value-based kind. This is where healthcare professionals can now be paid for quality rather than the quantity of a service.
So for the last 15 years, I have been trying to work in this struggling industry, trying to pivot the majority to this new model. Frankly, a lot of individuals and health professionals are making a lot of income off of the health industry in the US, which obviously they are not easily going to be willing to give up or adjust. Usually it is diagnostics or tests in laboratories which are the main revenue generators. Of course every individual has their own best interests at heart which is understandable, but often there are unspoken interests behind these actions such as ulterior ultimatums. This can be suggesting the most expensive treatments when cheaper alternatives are available. However this will bankrupt the nation if we do not act on this problem. So I have been really involved with improving this issue, trying to find ways to apply technology to do so. This is where I think AI comes in to help. AI can be really beneficial In terms of its diagnostic capabilities, being able to augment a professional’s action. However, I do not believe that AI will be replacing doctors in mass any time soon. Having said that, in some areas such as within Radiology a machine can read more images and recognize the finer details. Machines compared to clinicians, can work continuously, without having physical needs, therefore being more efficient and accurate. As a result we often see radiographers being replaced by machines. This is just one small problem that we face for a future that incorporates automation.
WHAT AREAS OF HEALTH TECH ARE YOU MOST PASSIONATE ABOUT?
Other than the obvious areas of digital health, machine learning, algorithmic solutions, automation, AI, Blockchain, data, digital transformation, I am most passionate about payment models, specifically within new payment and care delivery models. Technology cannot simply just be implemented within a place of work. Work flow adjustments need to be enforced and when considering the technology side of things, there needs to be successful integration and interoperability between systems. For years I was working in between a medical centre and working for a health system, consulting. Here I had some large industry clients including the Federal Government and Aetna. General practice was that the clients would renew their contracts with the healthcare department; however Aetna decided not to go through with the extension of the contract, just wanting to hire my services instead.
So during that time period I was exposed to a broader scope and scale within the health industry. These included huge health systems, incorporating giant facilities which could hold up to 3,000+ beds in some of the larger hospitals around the world. It was interesting to see how all these systems are set up, understanding the processes that are in place. It was also interesting, from a technology perspective, to observe the interrelated systems that are not interconnected. These systems use lots of manual processes that could be automated to a degree. This made me realise that there is not an instant flip over from volume to value-based payment systems and health care delivery. I believe that outcomes are what actually matters. Did the patient actually get better or did a healthcare professional prolong the process?
WHICH HEALTH TECH INFLUENCERS INFLUENCE YOU?
The first person that came into my mind was that of Tim O’Reiley. Tim speaks regularly about open source, digital transformation and about the Web 2.0 paragon. These are three elements I am extremely passionate about. Additionally, one of the other things I have been really interested in, outside of the healthcare industry, is efficiencies in government. Specifically I have a desire to try and return the power that has been usurped by governments, back to the people. Tim wrote a wonderful paper on the topic of ‘government as a platform’. He advanced the idea of ‘Web 2.0’ to ‘Government 2.0’. However he did not coin the term of ‘Health 2.0’, this was put forward as a term by Matthew Holt. This was along the same lines nevertheless. Both health and government could benefit from an upgrade. This should be thought of as a platform for innovation.
Secondly, someone who influences me drastically is Brian Behlendorf. He was the primary developer of the Apache Web Server, which is by far the most popular web server software on the internet. He has been on the board of the Mozilla Foundation for 15 years and also is on the board for the Electronic Frontier Foundation which is another area that focuses specifically on neutrality and the sourcing of the Internet. Since the early 90’s he has been instrumental in the development of the internet. He started as a student in Berkley, California and continued throughout his adult years. He has recently founded a new group called Hyperledger. This is an umbrella project which uses open source tools and Blockchain technology. This was initially started as an organization within the umbrella of the Linux foundation, where Brian is also on the board. Hyperledger has lots of interesting developed platforms based on Blockchain technology.
Moving on, another influencer that inspires me is Melanie Swan. Melanie is a philosopher, a university lecturer and a technology futurist. She has written a great book called ‘Blockchain Blueprint for a New Economy’ and then went on to found the Institute for Blockchain Studies. She has a great way of going about explaining the technology behind Blockchain and how things could work in the future with the innovation of technology.
Another influencer, more relevant to notion of machine learning and AI is Andrew Ng. He is a Chinese American computer scientist working as a Head Scientist for Baidu. He is also an Adjunct Professor at Stanford University. Additionally he is the Co-founder and chairman of Coursera, an online Educational Platform. This is how I learnt about machine learning. I took online classes and indulged in the topic through his teachings!
An influencer who specializes in HealthTech is Daniel Craft MD who additionally is a Physician. He works explicitly with exponential Medicine at Stanford University, being involved in a lot of the same efforts that myself and others have been involved within. Being a physician, this has allowed him to portray a particular point of view that is very beneficial.
Another is Rasu Shrestha. He has a MD and Masters in Business Administration and Healthcare. he also practices Medicine, being a real thought leader which has led my own mind to drift and discuss issues involving deeper understanding.
Another dominant influencer to me, is Bertalan Meskó who is a Hungarian physician, calling himself a ‘Physician Geek’. On top of his MD he also has subsequently gained a PhD in Genomics. He is also one of ‘Amazon’s Top 100 Authors’ which indicates his ability to write great content, speak well and research well too. He is additionally a Futurist, referring to himself as the ‘Medical Futurist’.
Lastly, someone who is hugely influential to me is an individual called Ray Kurzweil. He focuses specifically on exponential information technology and futurism. He puts forward a notion that the price point of computing is never linear. People automatically jump to Mores Law which is just one expression of exponential advance of information technology. But you can apply the same theory throughout. You can observe that the graphs always marry each other, which I think is truly mesmerising.
OUTSIDE OF HEALTH TECH WHO ELSE INFLUENCES YOU ?
Firstly the Government has always been hugely interesting to me as a topic outside of Health Tech. I was a City Councilor in Oregon serving a four year term. This was really interesting and helped drive the point even further home. Government can usually be one of two things in nature. It can usually either be extremely helpful or dangerous. When you consider human history, the government has caused some huge problems in the past for mankind. I love reading and listening to human history, learning about how we got to where we are today and what the problems were that were either overcome or not overcome by good government. That is why Tim O’Reiley really stands out to me as mentioned earlier. He suggested the concept of ‘Government 2.0’, stating that government is a platform for innovation, which as a notion is totally inspirational. I completely agree with his writing and am an avid attendee to his conferences on the topic.
WHICH BRANDS OR PRODUCTS STAND OUT FOR YOU IN HEALTH TECH?
There are definitely lots of brands out in the market that are doing amazing work and I don’t want to leave any of them out. However I do want to mention a few that I believe show an intelligent and smart approach. I just want to say a brief apology to all the brands or products I may have missed out and haven’t ‘lifted’ personally. Some of the brands that I really admire are commonly within a start-up community, but not always.
First of all, I think IBM as a brand has done some great work in areas such as AI and Blockchain technology and they are a huge company. I am on the technology side of operations so of course all the open source involvements are important.
A lot of the innovative work out there is being done is by the smaller individuals and start-ups that are working in the trenches including a company called GEM. This brand incorporates a lot of really key themes with AI and Blockchain too. There are not a lot of brands out there however that I think are truly thoughtful and accurate on what they are doing. One of the organizations that I am a member of, that are doing fantastic work is the IEEE. They have a lot of different components to them. One of the things that they have just implemented is a society for computing. They have based this on the new phase of computing.
IF A BRAND WANTED TO WORK WITH YOU, WHAT OFFLINE / ONLINE ACTIVITIES WOULD YOU BE MOST INTERESTED IN?
I would be very interested in getting involved in augmented reality and virtual reality which has become widely used in health. There has been a huge variety in how these elements can benefit the health industry from VR surgery’s having taken place, to AR being used to help PTSD patients recover. So in whole, I definitely think there is a big space for these elements in the industry.
I would be more than happy in pulling together a team. This is made easier using my previous experience in a leadership role, working as an Adviser and an Official. I have been preaching a message throughout my career to others, that I borrow off of Tim O’Reiley. Paraphrasing his words: ‘You should always provide more value than you capture’. Initially, this sounds to a lot of people like a good business plan, but you’re never actually going to get anywhere following it. Actually this approach really works, being the right thing to do. For instance when a technology company needs help with a strategy, I give them the advice ‘do not do anything stupid just for the money’. People and companies need to consider the consumer. Data is a passion of mine and a key element to the health industry.
DNA for example is a personal and confidential element, belonging to an individual and I feel that only the individual should have access to this data. This being said, the consumer should always be considered. Where is this data going? Companies use AI and Algorithms to basically sell advertising as this is a business model. This is the same story in the health industry. This is fine; I’m not against that at all, as long as there is transparency.
Moving on from this, I would also like to become involved within and collaborate with a brand working in product development. However there are many individuals out there that may be more experienced in this field. More relevant for my skill set is that I seem to have a knack for pulling together effective teams. I have a very large network of individuals in the industry that I could pull from. People listen to me. Primarily this is because I preach what I believe and I’m not selling something onto people. I am a wild card and unpredictable but there is no point trying to predict the future as it hasn’t happened yet.
Considering the co-creation of content, I would love to get involved in creating white papers and blogs additionally. I do not write for payment, I do it because I am interested.